Thursday 10 December 2009
Wednesday 2 December 2009
Compensation or Remediation?
The argument (or perhaps it is better understood to be a "tipping point" in intervention with people with disabilities) of whether to act to change the person, or act to change the world in which the person operates, has a long history, but it is not often talked about. Parents make the conscious choice to move towards one or the other at different times in a dependent's life. This often causes disagreement with people whose job it is to intervene professionally in that child's (or in some cases, adult's) life. The speech pathologist who wants to continue to work on remediation of a communication problem - and the parent who has decided to just let things be. The orthodontist who wants to continue to work on a person's smile - and the patient (or family member) who decides that s/he has spent enough money on braces. The behavioural consultant who wants to continue to work on reducing ritualistic behaviour and the parent who decides that the ritualistic behaviour is just part of the child's unique character and it is not worth the effort needed to eliminate it from the child's repertoire. The self-advocate who opts out of programs intended to remediate, retrain, rehabilitate or otherwise change him (her),and say, "just accept my differences".
Wolfensburger in his exposition of "Social Role Valorization" (see Wolfensberger and Thomas, PASSING, 1983, for example) talks about "Personal Competency Enhancement" on the one hand (changing aspects of the person to better their "fit" into the world that is), and "Social Image Enhancement" on the other (changing the world in which a person operates to change the "fit" of the world around them). Of course, the processes are complementary, and both are appropriate targets of intervention. Their manual for program analysis of service systems' implementation of normalization goals provides a number of examples of how both processes can be utilized to influence positive outcomes for people.
In my view, all forms of intervention can be subdivided into one or the other of these approaches. Diet and nutrition interventions clearly aim at improving personal competency. Legal interventions to gain access to services act more to change the world ("Social Image Enhancement")in which a person operates.
A professional working with people with special needs may become too focused on their responsibilities to change the person for a variety of reasons. One in particular, it is just downright hard to change the world. So an easier route might be to try to make the person fit better. This has been referred to as the "square peg in a round hole" argument. Just shave off the corners until it fits.
Self-advocates are likely to point out that this is the kind of thinking that led to the development of residential schools in Canada for its aboriginal population. This not only did not work, but has been an embarrassment for government, religious orders that sponsored such schools, and a lasting legacy of disappointment, to say the least, for former students.
For this reason, I have long argued that if a professional fails to address, to the limits of their competence and capacity, BOTH remedial and compensatory approaches in their practice, they are failing their client at some level, and this would constitute unethical practice. Not enough so perhaps to report them to their professional colleges or ethics bodies, but unethical practice nonetheless.
Compensatory practices might be exemplified by admonishing other professionals, school personnel, or residential treatment staff, among others, when those individuals want behavioural conformity from a person with learning disabilities that would be unnecessary in a "normalized" or "valorized" setting. I am less impressed with the person who says, using empirically derived procedures, that they can teach a pigeon to play Mozart, than I am by the person who asks them, with all appropriate sincerity, why they would want to do that.
Wolfensburger in his exposition of "Social Role Valorization" (see Wolfensberger and Thomas, PASSING, 1983, for example) talks about "Personal Competency Enhancement" on the one hand (changing aspects of the person to better their "fit" into the world that is), and "Social Image Enhancement" on the other (changing the world in which a person operates to change the "fit" of the world around them). Of course, the processes are complementary, and both are appropriate targets of intervention. Their manual for program analysis of service systems' implementation of normalization goals provides a number of examples of how both processes can be utilized to influence positive outcomes for people.
In my view, all forms of intervention can be subdivided into one or the other of these approaches. Diet and nutrition interventions clearly aim at improving personal competency. Legal interventions to gain access to services act more to change the world ("Social Image Enhancement")in which a person operates.
A professional working with people with special needs may become too focused on their responsibilities to change the person for a variety of reasons. One in particular, it is just downright hard to change the world. So an easier route might be to try to make the person fit better. This has been referred to as the "square peg in a round hole" argument. Just shave off the corners until it fits.
Self-advocates are likely to point out that this is the kind of thinking that led to the development of residential schools in Canada for its aboriginal population. This not only did not work, but has been an embarrassment for government, religious orders that sponsored such schools, and a lasting legacy of disappointment, to say the least, for former students.
For this reason, I have long argued that if a professional fails to address, to the limits of their competence and capacity, BOTH remedial and compensatory approaches in their practice, they are failing their client at some level, and this would constitute unethical practice. Not enough so perhaps to report them to their professional colleges or ethics bodies, but unethical practice nonetheless.
Compensatory practices might be exemplified by admonishing other professionals, school personnel, or residential treatment staff, among others, when those individuals want behavioural conformity from a person with learning disabilities that would be unnecessary in a "normalized" or "valorized" setting. I am less impressed with the person who says, using empirically derived procedures, that they can teach a pigeon to play Mozart, than I am by the person who asks them, with all appropriate sincerity, why they would want to do that.
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